Sleeve plus procedures: need of time.

Laparoscopic sleeve gastrectomy as a standalone procedure has gained a lot of popularity over laparoscopic Roux-en-Y gastric bypass in the last decades and is the most frequently performed bariatric procedure worldwide; however, the long-term results are not promising in terms of weight regain and re-emergence of comorbidities. Considering the proven concept of biliopancreatic diversion with duodenal switch, many novel procedures have been developed involving a sleeve gastrectomy along with some intestinal bypass or alteration in small intestine anatomy. These procedures show better technical feasibility and are associated with less post-operative morbidity, sleeve plus procedures permanently adopt the digestive tract to the present lifestyle, by eliminating the gastric storage of hypercaloric and excessively processed food, and providing the ileum with the needed stimulus for incretin release.